OB: Test 2 Flashcards
The occurrence of a seizure in a woman with preeclampsia who has no other cause for seizure =
Eclampsia
A syndrome involving an increase in BP >140/>90 after 20 weeks gestation accompanied by proteinuria in a woman who was normotensive before 20 weeks =
Preeclampsia
What is HELLP syndrome?
Hemolysis, Elevated Liver enzymes, & Low platelet count; associated with severe preeclampsia, although it may occur in women with normal or minimally elevated BP & no proteinuria; usually before 36 weeks gestation but can occur postpartum; leads to vasospasms, epithelial damage, hyperbilirubinemia, impaired liver function/necrosis.
What are some s/s of HELLP syndrome?
HTN, malaise, flu-like symptoms, epigastric pain, n/v, h/a, small number have bruising or hematuria.
Risk factors for preeclampsia:
- Primigravida
- Age extremes (<16 or >40)
- AA’s
- Obesity
- Personal or FH preeclampsia
- Abundance of trophoblast tissue (hydatidiform mole, multiple pregnancy)
- Preexisting DM type 1, HTN, Renal dz, or Vascular dz
- Thrombophilias–Factor V Leiden
- Periodontal disease
Clinical manifestations of preeclampsia/eclampsia:
H/A, Hyperreflexia (with or without clonus), nausea, seizures, CHF, pulmonary edema, dyspnea, risk of DIC, proteinuria, Oliguria, wt. gain, dependent/non-dependent edema, epigastric pain, heartburn (RUQ), elevated liver enzymes, liver rupture, retinal edema, double vision, placental hypoxia/IUGR/PTL/Abruption
Best prevention methods for preeclampsia:
Early prenatal care, early ID of those at risk, early detection of dz
Nursing management for Preeclampsia:
- Position: left lateral recumbant
- Assess BP q1-4h
- Monitor urine for volume and proteinuria qshift or qhour depending on agency
- Assess DTR’s and clonus
- Assess for edema
- Give mag sulfate per infusion pump as ordered (and assess for toxicity)
- Provide balanced diet that includes 80-100 g/day or 1.5g/kg/day
- Pulmonary status: crackles/wheezing
- daily weights/I&O’s
- Seizure precautions
- Lab evaluation
- Fetal status
What is the drug of choice for anticonvulsant therapy for preeclampsia?
Magnesium sulfate.
What drug is associated with reduced incidence of HTN disorders in pregnant women if started before 16 weeks gestation (for women with increased risk)?
Low-dose ASA
What corticosteroid may be given to women with severe preeclampsia whose fetus has an immature lung profile?
betamethasone or dexamethasone.
What position should someone with severe preeclampsia be in?
Left lateral position
With severe preeclampsia, regardless of gestational age, deliver if:
Placental abruption HELLP Oliguria Pulmonary edema Eclampsia DIC
Nursing care management for Eclampsia:
- Assess for signs of impending seizure (persistent h/a, epigastric pain, hyperreflexia with clonus)
- Remain with patient, call for assistance
- Ensure patent airway/positioning/suction (lower HOB/turn to side, padded rails up)
- Note onset and duration
- Observe for possible aspiration/oxygenation
- Maintain patient in quiet, non-stimulating environment
- MgSO4, valium
- Treat fetal bradycardia
- Assess uterine activity–contractions, ROM, abruption
What is a therapeutic dose of Magnesium sulfate?
4.0-8.0 mg/mEq/L
Mag sulfate is a CNS-____ and vaso_______.
depressant (prevent seizure); vasodilator (slight dec. of BP).
S/s of Magnesium sulfate toxicity:
- Feeling of warmth, flushing, diaphoresis
- depression of CNS: DTR’s absent to 1+; change in LOC (drowsiness, lethargy, slurred speech)
- Depressed cardiac/respiratory function: RR <12/Sons of Anarchy; bradycardia—cardiac arrest
- Oliguria
- Elevated serum magnesium level
What do you do if magnesium sulfate toxicity is suspected?
Discontinue infusion immediately; antidote (calcium gluconate) should be at bedside
What is the antidote for Magnesium sulfate toxicity?
Calcium gluconate
What are the 4 essential forces of labor?
Passageway, Passenger, Power, & Psyche
What type of shape of bony pelvis do we want?
Gynecoid: round, maximum diameter.
CPD =
Cephalopelvic disproportion
The cranial bones of the baby during birth overlap under pressure called _____
molding.
The anterior fontanelle is ___-shaped and about ___ cm. The posterior is ___-shaped and about ___ cm.
diamond; 2-3 cm; triangle; 1-2
Macrosomia =
birthweight >4000g (8 lb, 14.5 oz).
Macrosomia most likely occurs with:
Family hx, multiparity, AMA, excessive maternal wt gain, DM, postterm gestation, male fetus
___ refers to the relation of the fetal body parts to one another. The posture the fetus assumes as it conforms to the shape of the uterine cavity.
Fetal attitude.
___ refers to the relationship of the long axis of the fetus to the long axis of the mother. It may be either longitudinal (vertical), transverse (horizontal), or oblique.
Fetal lie.
Fetal attitude may be described as ___ or _____.
Flexion (normal; arms folded, back curved forward, head bent on chest); or Extension
Fetal lie can be described as ___, __, or ____
Longitudinal (99% of pregnancies–cephalocaudal axis of fetus is parallel to mom’s spine); Transverse or Oblique lie (baby’s spine is at right angle to mom’s spine)
_______ is determined by fetal lie and refers to the body part of the fetus that enters the maternal pelvis first and leads thru the birth canal during labor.
Fetal presentation.
How can fetal presentation be described?
1) Cephalic: Vertex/occiput (most common; smallest diameter of fetal head presents bc fetal head is completely flexed to chest)
Sinciput/brow: top of head presenting part
Face: face first
Mentum: chin
2) Breech: Complete: fetal knees/hips both flexed, thighs on abdomen; butt and feet present to maternal pelvis
Frank: Fetal hips flexed, knees extended; butt presents to maternal pelvis
Footling: hips and legs extended; feet present to maternal pelvis; can be single or double (one foot or two)
3) Shoulder: when shoulder is presenting part; fetus is in transverse lie and acromion process of scapula is landmark
4) Compound Presentation: more than one body part (ie head and fingers; butt & toes)
___ is the relationship of landmarks (occiput, mentum, sacrum, shoulder) of presenting part to sides, front, back of maternal pelvis.
Fetal position.
Three notations used to describe the fetal position:
- Right (R) or Left (L) side of maternal pelvis
- The landmark of the fetal presenting part: Occiput, mentum, sacrum, or acromion (O,M,S, or A)
- Anterior, Posterior, or transverse (A,P,orT) depending on whether the landmark is in the front, back, or side of the pelvis.
The time between the beginning of one contraction and the beginning of the next contraction =
frequency
___ of the presenting part occurs when the largest diameter of the presenting part reaches or passes thru the pelvic inlet.
Engagement
The presenting part is said to be ____ when it is freely movable above the inlet.
Floating or ballottable.
___ is where the PP (presenting part) is in relation to the ischial spines.
Station.
What are the 7 Cardinal Movements of Labor?
Engagement Descent Flexion Internal rotation Extension External Rotation/Restitution Expulsion
“Every darn fool in Egypt eats raw eggs.”
The measure from the beginning of the contraction to the completion of the contraction =
duration
___ refers to the strength of the uterine contraction during acme.
Intensity
Used to graph progress of dilation/station up until delivery =
Friedman’s Curve
What is an average rate of dilation for women in labor?
Women may vary in the time it takes to get to about 4 cm (hours, days), but at 4, multips usually go about 1.5 cm/hour and primips about 1 cm/hr
3 phases of each contraction:
1) increment: “building up” of the contraction; longest phase
2) acme: peak
3) decrement: “letting up” of contraction.
Then period of relaxation between contractions.
What are 4 hormones that may affect the onset of labor?
Progesterone (withdrawal), Estrogen (cause contractions), Prostaglandin E (contractions and softens cervix), Oxytocin stimulation (contractions).
Premonitory Signs of Labor (Impending signs of labor):
- Braxton Hicks Contractions (the irregular, intermittent contractions–may start to become uncomfortable)
- Lightening (10 days-2 weeks before for primip/day of for multip)
- Mucus plug expelled/bloody show: pink to red mucous; means cervix is getting soft
- SROM
- Burst of energy: 1-2 days before
- Diarrhea
- Wt. loss
- Sleep disturbances.
What are some major differences between true and false labor?
True: *Cervical dilation/effacement progressive (nothings gonna stop them)
Contractions regular intervals and intervals between gradually shorten
C’s increase in duration and intensity
*Discomfort: in back and radiates to abdomen
*Intensity increases with walking
*C’s don’t dec. with rest/warm tub bath
False: *Cervical dilation/effacement=no change
C’s irregular, no change in intervals, duration, intensity
*Discomfort just in abdomen (not back)
*Walking has no effect on or lessons C’s
*Rest and warm tub baths lessen contractions
Physical Changes related to Labor:
Cardio: blood flow to placenta stops (redistributes to uterus); 300-500 mL; Increased CO/HR/BP; WBC’s Inc.
Resp: Inc. RR/O2 demand/hyperventilation; diaphoresis
GI: decreased motility/gastric emptying; n/v common; dry lips/mouth
Renal: Inc pressure on bladder/urethra; polyuria common
Go over assessment guide on p 560-63
.
How is hydration provided during the 1st stage of labor?
IV (usually at about 125 mL/hour); ice chips and popsicles only foods allowed.
Stage of labor that begins with the beginnign of true labor and ends when the cervix is completely dilated at 10 cm =
First stage
Stage of labor that begins with complete dilation and ends with the birth of the infant =
2nd stage
Stage of labor that begins with the birth of the infant and ends with the expulsion of the placenta =
3rd stage
Stage of labor 1-4 hours after expulsion of the placenta; uterus is contracting to control bleeding; care of newborn and mom begins
4th stage
Stage of labor with dilation and effacement =
1st stage
Stage of labor with period of descent and birth =
2nd stage
Stage of labor that is the birth of the placenta =
3rd stage
What are some positions for the 2nd stage of labor?
dorsal lithotomy in semi-fowler’s position; squatting, lateral, kneeling, sitting, standing
What do you do if there’s meconium-stained fluid in baby’s mouth at birth?
below vocal cords=need to suck out; above–don’t do anything
At 5 mins following birth, the baby’s heart rate is 96, respiration is slow and irregular, there is some flexion of the extremities, there is a weak cry with flicking of the foot, acrocyanosis is present. What is the Apgar score?
5
Go over infant resuscitation: in ipad under photos; 47: 24 under lecture on nov 7
.
What are the 5 parts of Apgar and the score for each:
Heart rate: 0=absent; 1=below 100; 2=above 100 Respiratory effort: 0=absent; 1=slow--irregular; 2=good crying Muscle tone: 0=flaccid; 1=some flexion; 2=active motion Reflex irritability (evaluated when baby is dried or by rubbing soles of feet): 0=no reaction; 1=grimace; 2=vigorous cry Color: 0=pale blue; 1=body pink/blue extremities; 2=completely pink
What do the Apgar scores mean?
7-10=baby in good condition
4-7: need for stimulation
under 4: resuscitation
During the 4th stage of labor, we want a blood loss of less than _____
500 mL
What does the nurse do if she has to start the delivery without the MD?
- Do NOT leave mom alone/call for assisstance
- Stay calm
- Have her blow, not push
- Get the Precip tray ready/sterile glove: tray has everything needed for delivery
- Clean perineum if time allows
- Stretch/support perineum
- Control delivery of head
- Check for nuchal cord one head is out: unwrap it from around neck
- Once head is out, suction out mouth and nose
- Deliver anterior then posterior shoulder
- deliver body
- Double clamp, then cut cord
- Spontaneous delivery of placenta
- Pitocin
Gravida=
any pregnancy, regardless of duration, including current pregnancy
Nulligravida=
a woman who has never been pregnant
A woman who is pregnant for the first time =
Primigravida
A woman who is in her second or subsequent pregnancy =
Multigravida
1 pound = how many grams?
454
Para =
woman bore offspring that have reached age of viability, regardless if born dead or alive; >20 weeks gestation/>500 grams
A woman who has not given birth past 20 weeks =
Nullipara
A woman who has given birth to her first child past age of viability, whether or not born alive =
Primipara “primip”
A woman who has had 2 or more at 20 weeks gestation =
Multipara –“multip”
A birth that occurs prior to the end of 20 weeks gestation; either spontaneous or elective; fetus <500g
abortion
A fetus born dead after 20 weeks gestation =
Stillbirth
Perinatal =
Pregnancy thru the 1st year after giving birth
Time from birth until the woman’s body returns to pre-pregnant condition; aka Puerperium =
Postpartum
Time from onset of labor until birth of baby and placenta =
Intrapartum
Time between conception and onset of labor =
Antepartum
Number of weeks since last menstrual period =
Gestation
Term baby = ___ weeks
38-42
Postterm baby = ___ weeks
greater than 42
Preterm baby = _____ weeks
20-37 weeks
What position should the woman be in for her vag exam during pregnancy?
supine or tilted on left side (to be off vena cava)
Can use ___ paper to test for rupture of membranes. What color will it turn if amniotic fluid is present?
Dark Blue
What is the definitive test for presence of amniotic fluid in cervical mucous?
Fern test
Thinning and shortening of the cervical os =
Effacement
Opening of cervical os =
Dilation
Effacement ranges from 0 to ____
100%
What color is amniotic fluid?
clear/staw-colored
The relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis =? How is it measured?
station; presenting part higher than ischial spines=negative number, noting cm’s above zero station; station -5 is at the inlet down to +5; 0 is at level of ischial spines
A station of about ___ equals crowning.
+3 or higher
How is the first stage of labor divided up?
3 phases:
1) Latent (0-3 cm dilated)
2) Active (4-7 cm)
3) Transition (8 cm to complete/10 cm dilated)
Which subphases of the 1st stage of labor are the longest and shortest?
*Latent: longest usually: hours-days
Active: contractions increasing
*Transitional: Shortest: lots of contractions.
How does the epidural affect the length of labor?
may lengthen it or shorten it
How often should you encourage the woman to void during the 1st stage of labor?
every 1-2 hours